1. Ethics Applied to Nursing: Personal vs. Professional Ethics Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Ethical Issues in 21st Century Health Care (p. 118 ) In vitro fertilization Artificial insemination Surrogate motherhood Cloning Organ donation Including cadaver, child, and aborted fetus donations Stem cell research/procedures Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 2

3. Ethical Issues in 21st Century Health Care (cont’d) (p. 118 ) Abortion Euthanasia Assisted suicide Advance directives Living wills, power of attorney Right to die Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 3

4. Description and Scope of Ethics (p. 118-119 ) Ethics is a system of standards or moral principles that directs actions as being right or wrong. Concerned with the meaning of words such as right, wrong, good, bad, ought, and duty. Concerned with the ways people, either individually or as a group, decide the following: What certain actions are right or wrong If one ought to do something If one has the right to do something If one has the duty to do something Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 4

5. Morals and Values (p. 119 ) Morals Concerned with dealing with right or wrong behavior (conduct) and character Values Involve the worth you assign to an idea or an action Freely chosen and are affected by age, experience, and maturity Continue to be modified throughout your lifetime, as you acquire new knowledge and experience Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 5

6. Comparison of Legal Aspects of Nursing and Ethics (p. 119 ) Nursing Ethics: the values and principles governing nursing practice, conduct, and relationships Responsibilities: focused on ideal behavior, morality, and higher standards Legal Aspects: state statutes that apply to licensed persons and the situations in patient care that could result in legal action Responsibilities: focused on rules, regulations, and obligations mandated by law Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 6

7. Ethical Codes of NAPNES and NFLPN (p. 119 ) NAPNES Codes—National Association of Practical Nurse Educators and Services NFLPN Codes—National Federation of Licensed Practical Nurses Nurse Practice Acts—published by each state Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 7

8. Your Personal Code of Ethics (p. 120 ) You ultimately choose what your personal code of ethics will include. Will influence your nursing ethics When personal ethics conflict with the law, you are obligated to follow the law. You may ethically refuse to assist with a procedure, but postprocedure you cannot refuse to give nursing care to the patient involved Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 8

9. Roots of Nursing Ethics (p. 120-121 ) Before nursing process and critical thinking were added to nursing curricula, those in the nursing profession did not see themselves as having something separate to contribute to patient care Nursing ethics was primarily a modification of medical ethics and ethics of other professions at that time Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 9

10. What Changed? (p. 121 ) Past Study of nursing was initially disease-oriented Nursing assessments did not exist Additional concerns the patient might have had were not routinely assessed Patients were expected to follow physicians’ orders without question The nurse’s job was to see that the orders were followed Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 10

11. What Changed? (cont’d) (p. 121 ) Present Nurses discovered that in addition to their dependent role to physicians, they had something special to contribute to the patient Nursing process helped nurses identify additional needs that could be responded to through nursing care Patients were encouraged to play an active part in planning and implementing their nursing care plan Adding nursing process and critical thinking changed the nursing role and changed nursing philosophy Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 11

12. Ethical Decisions in Health Care (p. 121 ) Began to see the patient as more than just a disease Western secular belief system Individual autonomy: patient’s freedom to choose Individual rights: patient’s rights are limited if they clash with the health professional’s Ethical and legal responsibilities Patient advocacy Accountability Peer reporting Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 12

13. Ethics Committees (p. 121 ) Multidisciplinary team assists with difficult ethical decisions Usually the discussions relate to new or unusual ethical questions Patients arrive with their cultural- and/or their religion-based ethics What the person can and cannot do in regard to their health care has already been established by the culture of which they are a part Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 13

14. Western Secular Belief System (p. 121 ) Individual autonomy “Self-rule” Individuals have the capacity to think, and based on these thoughts, make a decision freely whether or not to seek health care (the freedom to choose) Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 14

15. Western Secular Belief System (cont’d) (p. 121 ) Individual rights The ability to assert one’s rights The extent to which a patient can exert his or her rights is restricted An individual’s right has become a central theme of health care Right to consent to care Right to choose between alternative treatments Women’s rights over their own bodies Right to consent to or refuse treatment Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 15

16. Ethical Responsibilities of Nurses (p. 122 ) Patient advocacy The patient needs to be informed of what you will be doing with him or her (e.g., steps of a procedure) Accountability You are answerable to yourself, to your assigned patient, to the team leader, to the physician, and to your instructor who evaluates your work Peer reporting Report peers for behaviors that are potentially harmful to patients Copyright © 2013 by Elsevier Inc. All rights reserved.line.Slide 16

17. Principles of Ethics (p. 122 ) You can add knowledge of basic ethics to critical thinking as you assist the RN with the nursing process Learning about ethics is more than being able to recite the definition to pass a test. It means being able to help make ethical decisions when ethical dilemmas arise Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 17

18. Principles of Ethics (cont’d) (p. 122-123 ) Nonmaleficence (Do No Harm): the principle of doing the least amount of harm possible to a patient Most beneficial treatments involve harming the patient to some extent Examples: Skin puncture Drug side effects Physical manipulations Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 18

19. Question 1 Which of the following deal with right or wrong behavior and character? 1. Ethics 2. Morals 3. Values 4. Laws Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 19

20. Question 2 Jessica is assigned to a patient named Bill, who is AIDS- positive. She tells her charge nurse that she refuses to take care of the patient. Which is the correct statement? 1. She is entitled to refuse the patient. 2. She is entitled to refuse the patient as long as it is before she enters the room. 3. She may not refuse to take care of the patient. 4. She may talk to her nurse manager to see what the policies in the facility state. Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 20

21. Question 3 Sherry is having a difficult time with a patient situation. A 2-year-old patient needs a blood transfusion and it has become a life-threatening situation. Her parents are Jehovah’s Witnesses and refuse the treatment. What hospital area should get involved in this situation? 1. Medical ethics committee 2. Employee improvement committee 3. Personal values committee 4. Law enforcement committee Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 21

22. Beneficence (p. 123 ) Two major nursing duties associated with beneficence (do good): Put patient interests first Place the good of patients before one’s own needs Includes organizational and other work-related needs Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 22

23. Autonomy (Free to Choose) (p. 124 ) Four steps of autonomous decisions Thinking through all the facts Deciding on the basis on an independent thought process Acting based on a personal decision Undertaking a decision voluntarily, without pressure from anyone else Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 23

24. Autonomy (Free to Choose) (cont’d) (p. 123 ) Patient’s right to privacy Choose care based on personal beliefs Accept or reject treatment Avoid needless exposure Personal values may be contrary to medical ethics Patient can refuse care for religious, cultural, or personal reasons Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 24

25. Fidelity (Be True) (p. 125 ) Fidelity: Acting in patients’ best interests when they are unable to make free choices Does not include resuscitation or paternalistic decisions Must differentiate between your own feelings and those of the patient Maintain patient confidentiality Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 25

26. Justice (Fair to All) (p. 125 ) Justice: Give patients their due and treat each patient fairly and equally (i.e., with dignity and respect) Avoid letting personal ethics and values interfere with patient justice Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 26

27. Question 4 Autonomy means all of the following except: 1. thinking through all the facts. 2. deciding on the basis of an independent thinking process. 3. having patients do whatever they want. 4. undertaking a decision voluntarily. Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 27

28. Question 5 Two nurses are discussing a very difficult patient on their floor in a full elevator on the way to lunch. The patient’s mother was in the back of the elevator and heard every word. This is an example of: 1. injustice. 2. breaching fidelity. 3. beneficence. 4. nonmaleficence. Copyright © 2013 by Elsevier Inc. All rights reserved.Slide 28